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Knie Journal

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02.01.2024 | Arthrosen | Leitthema

Indikationen und Kontraindikationen zum medialen Schlitten

verfasst von: Prof. Dr. med. C. Becher, M. T. Hirschmann, G. Matziolis, J. Holz, R. v. Eisenhardt-Rothe, J. Beckmann

Erschienen in: Knie Journal | Ausgabe 1/2024

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Zusammenfassung

Die unikondyläre tibiofemorale Endoprothetik (UKE) wird im Vergleich zur totalen Knieendoprothetik (TKE) trotz der potenziellen Vorteile immer noch vergleichsweise selten angewandt. Eine höhere Patientenzufriedenheit der UKE steht allgemein höheren Revisionsraten im Vergleich zur TKE gegenüber. Die Routine des Operateurs ist insbesondere bei der UKE für ein erfolgreiches Ergebnis von entscheidender Bedeutung. Ferner persistieren alte „Dogmen“ zu den Indikationen und Kontraindikationen. In dieser Arbeit werden die Indikationen und Kontraindikationen der UKE mit besonderer Berücksichtigung der Einflussfaktoren auf das klinische Ergebnis und Gründe für eine Revision dargestellt. Entsprechend den Literaturdaten sind fortgeschrittene Arthrosen des kontralateralen tibiofemoralen und des kontralateralen patellofemoralen Gelenkabschnitts sowie eine Instabilität der Seitenbänder und des hinteren Kreuzbandes die einzigen eindeutigen Kontraindikationen. Hingegen stellen ein erhöhter Body-Mass-Index, das Alter, die Chondrokalzinose, der vordere Knieschmerz mit patellofemoralem Knorpelschaden und auch ein defektes (insbesondere aber funktionell stabiles) vorderes Kreuzband keine eindeutige Kontraindikation dar. Allerdings sollte wie auch bei Zustand nach Umstellungsosteotomie und bei bestehenden Erkrankungen aus dem rheumatischen Formenkreis eine kritische Abwägung der Indikation erfolgen, um Fehlschläge zu vermeiden. Sportliche Aktivitäten bedürfen prinzipiell keiner Einschränkung mehr. Die Verwendung mobiler und fixer Inlays ist als äquivalent anzusehen. Das zementfreie Vorgehen mit mobilem Inlay scheint bei Übergewicht zu einer geringeren Lockerungsrate im Vergleich zur zementierten Versorgung zu führen.

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Titel: Indikationen und Kontraindikationen zum medialen Schlitten
verfasst von: Prof. Dr. med. C. Becher
M. T. Hirschmann
G. Matziolis
J. Holz
R. v. Eisenhardt-Rothe
J. Beckmann
Publikationsdatum: 02.01.2024
Verlag: Springer Medizin
Schlagwörter: Arthrosen
Arthrosen
Endoprothetik
Erschienen in: Knie Journal / Ausgabe 1/2024
Print ISSN: 2662-4028
Elektronische ISSN: 2662-4036
DOI: https://doi.org/10.1007/s43205-023-00253-4

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